Sign Shops

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Confirmation Email

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Contact Information

Your Name: email:
Business Name:
Number of Locations:
Phone:
Fax:

Effective Dates of Coverage

Package:
Auto:
WC:

Carriers

Current Carrier:
Package:
Auto:
WC:

Business Information

Ownership:
Are you within the city limits?
If no, township name:
Do you own or rent the building?
If you own, what is the replacement cost? $
Annual Sales/Receipts: $
How many square feet? sq. ft.
How old is your building?
Please describe any losses in the last three years

Replacement Costs

Assets include store, shop and/or office equipment, furniture.

Value of assets you own: $
Value of assets you lease: $
Value of computers: $
Deductible: $
What type of construction is the building you occupy?
Do you have a sprinkler system?

Autos

How many vehicles are registered in your business's name?
Auto #1 Make: Model: VIN: Cost New: $
Auto #2 Make: Model: VIN: Cost New: $
Auto #3 Make: Model: VIN: Cost New: $
Auto #4 Make: Model: VIN: Cost New: $

Other Information

Approximate payroll:
Clerical/Design: $
Shop Personnel: $
Owners are:
Do you own any other businesses?
If yes, describe type of businesses:

Privacy Policy: The J.P. McKeone Insurance Agency takes your privacy seriously. McKeone will use your information to obtain a quote or other specified services, but in so doing will not release your identifying information to any third party. Your contact information will be used only by the J.P. McKeone Insurance Agency to contact you at your request.

Notice: A request for a quote on this web site does not constitute an agreement between the user and J.P. McKeone Insurance Agency. Insurance is not in effect until a policy is issued and the premium is paid.